Emergency Nursing Procedures PDF

# Emergency Nursing Procedures ## 1. Oxygen ### Indications - Cardiopulmonary arrest - Chest pain - Hypoxemia ### Action - Maximizes O2 delivery to cells ### Dosage - 2 to 15 L/minute via appropriate device ### Nursing Considerations - Monitor O2 saturation regularly using a pulse oximeter -...

# Emergency Nursing Procedures ## 1. Oxygen ### Indications - Cardiopulmonary arrest - Chest pain - Hypoxemia ### Action - Maximizes O2 delivery to cells ### Dosage - 2 to 15 L/minute via appropriate device ### Nursing Considerations - Monitor O2 saturation regularly using a pulse oximeter - Avoid high flow administration in patients with concurrent COPD - Use an appropriate delivery device for the appropriate amount of O2 ordered. - Humidification, warming, and filtering of the delivered oxygen - Monitor for signs of oxygen toxicity ## 2. Aspirin ### Classification - Antipyretic and a non-opioid analgesic ### Indications - Treat Acute Coronary Syndrome (ACS) ### Action - Slows platelet aggregation, reducing the risk of further occlusion or reocclusion of the coronary artery or a recurrent ischemic event ### Dosage - The standard recommended aspirin dosage to treat ACS is 160 to 325 mg ### Nursing Considerations - Instruct the patient to chewable “baby” aspirin to speed absorption - Not given on an empty stomach - Monitor platelets count ## 3. Nitroglycerin ### Classification - Anti angina - vasodilator - anti hypertension ### Indications: - Treat ACS, angina, hypertension, heart failure ### Action: - Anti-angina helps resolve chest pain from ACS. - A potent vasodilator, relaxes vascular smooth-muscle beds; It works well on coronary arteries, improving blood flow to ischemic areas. - Decreases myocardial oxygen consumption allowing the heart to work with a lower oxygen demand. In peripheral vascular beds, nitroglycerin causes vasodilation and reduces preload and afterload, resulting in decreased cardiac workload ### Dosages - Sublingual 0.15 to 0.6 mg - Transdermal patch 5mg or 10 mg - IV 10-300mcg/min ### Nursing Considerations - Diluted in compatible solution is preferred than given undiluted - Assess location, duration, intensity, and precipitating factors of patient's anginal pain - Patients on IV nitroglycerin require continuous ECG and blood pressure monitoring - Be alert for overdose symptoms: Hypotension, tachycardia; warm, flushed skin becoming cold and cyanotic; headache, palpitations, confusion, nausea, vomiting, moderate fever, and 48 paralysis. Tissue hypoxia leads to coma, convulsions. ## 4. Morphine ### Classification - Opiate analgesia ### Indications: - Analgesic of choice for pain in myocardial infarction ### Action: - Narcotic analgesic. Pain relief immediately and last for 2 hours. - Inhibit transmission of pain impulse. - Relieve pulmonary congestion, lower myocardial oxygen requirement and reduce anxiety. ### Dosage - Bolus IV 2-10mg. repeated from 2 to 4 hours if necessary. - Infusion 2-5mg/hr in NS or D5W%. ### Nursing Considerations - Obtain baseline respiratory rate, depth, and rhythm and size of pupils before administering the drug. - Monitor I&O ratio and pattern. Report oliguria or urinary retention. - Frequently assess B.P (hypotension). Vital signs should be assessed frequently. - Oxygen and controlled respiratory equipment should be available. - Assess for pain relief. ## 5. Amiodarone (cordarone) ### Classification - Anti dysrhythmia ### Indications: - Atrial and ventricular tachy-dysrhythmias ### Action - Multichannel blocker (sodium, potassium, Calcium channel, and noncompetitive ∞ &ẞ blocker) - Class III Antiarrhythmic ### Dosage - The usual loading dose of amiodarone is 5 mg per kg given intravenously over 30 minutes, then 0.5 mg/minute for 18 hours by continuous I.V. infusion pressure. - Total dose over 24 hours should not exceed 2.2 g. ### Nursing Considerations - Usually diluted in G5% - Whenever possible administer through a central venous catheter - Monitor cardiac rhythm continuously. - Doses of dioxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when amiodarone is started. ## 6. Atropine ### Classification - Anti cholinergic ### Indications: - Symptomatic bradycardia(first choice) - Antidote for poisoning such as from organ phosphorus insecticides ### Action - Increases the heart through the anticholinergic effect ### Dosage - 0.5mg IV push and may repeat up to a total dose of 2mg ### Nursing Considerations - Take frequent vital signs, especially noting heart rate (be alert for development of VT, VF or rebound tachycardia). - Monitor blood pressure for improvement. - Monitor intake and out ratio in elderly patients as at risk for urine retention. - Assess the patient routinely for abdominal distention and auscultate for bowel sounds. ## 7. Dopamine ### Classification - Sympathomimetic, vasopressin, inotropic ### Indications: - To treat shock and correct hemodynamic imbalances. - Improve perfusion of vital organs. - To increase cardiac output, and to correct hypotension ### Action - Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. - Action is dose-related; large doses can cause mainly alpha stimulation ### Dosage - **Dose dependent drug:** - **At low rates of infusion (<5 mcg/kg/min)(renal dose):** Affect on dopaminergic receptors, caused vasodilatation in the renal, mesenteric, coronary, and intracerebral vascular beds, is accompanied by increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow so increase urine output without affect on blood pressure. - **At intermediate rates of infusion (5-10 mcg/kg/min) (cardiac dose):** Affect on the betal-adrenoceptors, resulting in improved myocardial contractility, increased SA rate and enhanced impulse conduction in the heart. There is little, if any, stimulation of the beta2-adrenoceptors (peripheral vasodilatation). Causes less increase in myocardial oxygen consumption. - **At higher rates of infusion (>10 mcg/kg/min) (pressor):** Affect on alpha-adrenoceptors, with consequent vasoconstrictor effects and a rise in blood pressure. The vasoconstrictor effects are first seen in the skeletal muscle vascular beds, but with increasing doses they are also evident in the renal and mesenteric vessels. At very high rates of infusion (above 20 mcg/kg/min), stimulation of alpha-adrenoceptors predominates and vasoconstriction may compromise the circulation of the limbs. ### Nursing Considerations - Monitor Blood pressure, pulse, respiration, ECG and hemodynamic parameters very 5-15 minutes during and after administration. - Monitor urine output frequently throughout administration. Notify if urine output decreases. - Palpate peripheral pulses and assess appearance of extremities routinely color and temperature. - Correct the following before give dopamine infusion: Acidosis as hypovolemia - Use large vein, check vein frequently for blanching or pallor which may indicate extravasations - Weaning infusion gradually to prevent sudden hypotension. ## 8. Dobutamine (dobutrex) ### Classification - Intropic, ẞl-agonist ### Indications: - Heart failure, cardiac decompensation - (Avoid in shock without adequate fluid replacement) ### Action - 1-Increase myocardial contractility & cardiac output without significant change in blood pressure, it increase coronary blood flow and myocardial O2 consumption. - 2. Positive chronotropic & inotropic effects which are balanced by a mild degree of vasodilatation so that myocardial oxygen demand is generally not increased. ### Dosage - Dobutamine is generally considered the inotrope of choice in patients with myocardial ischemia. - IV infusion is 2.5 to 20 mcg/kg/min titrated to desired patient response. A concentration of 250mg/250ml D5W yields 1mg/ml dose greater than 20mcg/kg/min can cause increase heart rate. ### Nursing Considerations - Hemodynamic monitoring is recommended for optimal effect (check BP and HR every 2 to 5 minutes). - Fluid deficit (Hypovolemia) should be corrected before infusion. - Use large vein for administration; an infusion pump should be used on regulate flow rate. - Monitor urine output continuously during administration. - Observe for adverse effect; tachycardia, hypertension, chest pain, shortness of breath and cardiac dysrhythmias. ## 9. Epinephrine (adrenaline) ### Classification - Cardiac stimulant, vasopressor, bronchodilator, Beta 2 Adrenergic Agonists ### Indications: - Cardiac arrest, hypersensitivity reaction, anaphylaxis, acute asthma at attacks, symptomatic bradycardia, sever hypotension ### Action - Increase myocardial contractility, HR, SBP and cardiac output and relaxes bronchial smooth muscles ### Dosage - **For patients in cardiac arrest:** give 1 mg intravenously (follow with 20 ml IV fluid) or 2 to 2.5 mg diluted in 10 ml normal saline endotracheally every 3 to 5 minutes, followed by five forceful inhalation. - **As vasopressor administer as IV infusion at 2 to 10 mcg/min and titrate to desired response 1mg/250 ml D5W yields 4 mcg/ml** ### Nursing Considerations - Monitor continuous ECG - Monitor BP and HR every 2 to 5 minutes during the initial infusion and during drug titration - Use an infusion device, and central venous catheter and avoid giving any medication in the lumen of CVC to avoid give bolus to patient and cause dysrhythmia. - Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. - Monitor blood glucose for loss of glycemic control if diabetic. ## 10. Noradrenaline (nor-epinephrine, levophed) ### Classification - Sympathomimetic, vasopressor ### Indications: - Hypotension caused by trauma, and shock and sever cardiogenic shock ### Action - Produce vasoconstriction, increase myocardial contractility and dilate coronary arteries so increase blood flow to all vital organs without increasing the workload or output of the heart ### Dosage - From 4 to 10 mcg/min initially then adjust to maintain desired blood pressure range usually 2 to 4 mcg/min. It must be diluted in 250 to 1000 ml of D5% as IV infusion. ### Nursing Considerations - Should be given in infusion pump and through large vein. - Patient should be on cardiac monitor. - Check flow rate and injection site continuously. - Monitor intake&output. - Be alert to patient's complaints of headache, vomiting, palpitation, arrhythmias, chest pain, photophobia, and blurred vision. - Titrate off in same manner as was started. ## 11. Calcium chloride ### Classification - Electrolyte ### Indications: - Acute hyperkalemia, Acute hypocalcaemia Calcium channel overdose, Antidote for magnesium sulfate. ### Action - Increases cardiac contractility. Calcium chloride replacement and maintain calcium in body fluids. ### Dosage - 2-4 mg/kg of a 10% solution; equilvent to 13.6 meq of calcium may be repeated at 10-minute intervals. ### Nursing Considerations: - IV line should be flushed between calcium chloride and sodium bicarbonate administration. Extravasations may cause tissue necrosis. - Administer calcium through central line slowly. - Monitor BP because peripheral vasodilatation will occur. - Continuously monitor ECG for onset of dysrhthmia. - Observe for adverse effect: bradycardia, cardiacarrest, constipation, fatigue, venous irritation, depression and tingling. ## 12. Magnesium sulfate ### Classification - Electrolyte, anti dysrhythmia, anti convulsion ### Indications: - Seizure associated with eclampsia - Preeclampsia - Hypomagnesaemia, torsade de points, life threaten ventricular dysrhythunia secondary to digitals toxicity ### Action - Magnesium sulfate replace and maintain magnesium levels in body fuilds. It depressed the CNS, producing anti convulsion effects, decrease incidence of dysrhythmia ### Dosage - **For cardiac arrest if torsade or hypomagnesaemia is suspected:** 1 to 2 g diluted in 10 ml D5W IV push - **For seizures:** give 1 to 4 gram as 10% solution, administer 1.5 ml of 10% solution intravenously over l minutes, as infusion of 4 g/250 ml D5W, don't exceed a rate of 4 ml/min - **For hypomagnesaemia:** give an infusion of 5 g/1000ml D5W over 3 hours (rate not exceed 3 ml/min) ### Nursing Considerations: - Continuous monitor ECG for dysrhythmia - Monitor HR and BP every 2 to 5 minutes during drug titration - Monitor respiration must at least 16 breath / min before a dose can be given to reduce the risk for respiratory arrest - Monitor renal status, urine output should be at least 25ml/hr - Calcium 5 to 10 meq can be given to reverse respiratory depression and heart block. ## 13. Sodium bicarbontate ### Classification - Electrolyte replenisher and systemic alkalizer ### Indications: - Correction of severe metabolic acidosis associated with severe renal disease, uncontrolled diabetes, and circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. ### Action - NaHco3 acts as an alkalinizing agent by releasing bicarbonate ions. ### Dosage - In an emergency situation it can be administered undiluted by direct IV injection. - Can be diluted in 0.9% sodium chloride, 5% glucose, glucose and sodium chloride ### Nursing Considerations: - Assess the client's fluid balance throughout the therapy. - Administer via a central line if possible. - Obtain arterial blood PH, PO2, PaCO2, serum calcium, sodium, potassium balance and renal function before and throughout the therapy. - Flush line before and after administration sodium bicarbonate. - Observe for adverse effect : restlessness, tetany, hypokalemia, alkalosis, hypernatremia and fluid overload.